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Ahmad RA, Orelaru F, Wu X, Kim KM, Fukuhara S, Patel H, Deeb GM, Yang B. Aortic root repair in acute type A aortic dissection: Neomedia or no neomedia. J Thorac Cardiovasc Surg 2024; 168:28-36. [PMID: 36621454 DOI: 10.1016/j.jtcvs.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Neomedia has been frequently used for aortic root repair in acute type A aortic dissection. We aimed to determine the efficacy and necessity of neomedia during acute type A aortic dissection root repair. METHODS From January 2010 to February 2021, 308 patients with acute type A aortic dissection underwent aortic root repair with neomedia (n = 132) or without neomedia (n = 176). Of these, 121 matched pairs were identified using propensity score matching based on age, sex, coronary artery disease, preoperative renal failure, acute stroke, prior cardiac surgery, cardiogenic shock, coronary malperfusion, preoperative cardiopulmonary resuscitation, and severe aortic insufficiency. RESULTS After matching, the preoperative demographics and comorbidities were well balanced in both groups. Compared with the neomedia group, the no neomedia group had less hemiarch (57% vs 69%, P = .05) and more zone 1 arch replacements (12% vs 4.1%, P = .03), shorter hypothermic circulatory arrest time (28 vs 36 minutes, P < .001), and shorter crossclamp time (120 vs 131 minutes, P = .02). Postoperative outcomes were similar, and the odds ratio by univariable logistic model of no neomedia for operative mortality was 0.83 (P = .76). Aortic root growth over 11 years (0.11 vs 0.16 mm/year, P = .66), 5-year freedom from greater than mild aortic insufficiency (84% vs 85%, P = .80), reoperation for root pathology (1 patient in each group), and 8-year survival (80% [95% confidence interval, 69-97] vs 71% [95% confidence interval, 55-82], P = .26) were similar between the neomedia and no neomedia groups. CONCLUSIONS In patients with acute type A aortic dissection, aortic root repair with or without neomedia was equally safe and effective. Neomedia use could be avoided in acute type A aortic dissection repair.
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Affiliation(s)
| | - Felix Orelaru
- Department of General Surgery, St Joseph Mercy, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Karen M Kim
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | | | - Himanshu Patel
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
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2
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Okada T, Minato N, Zempo N, Kanemoto S, Hosono M, Kuwauchi S, Uetsuki T, Kawaura T, Kitawaki T. Midterm Performance of the Autologous Adventitial Overlay Method in Aortic Surgery. Ann Thorac Surg 2024; 117:345-352. [PMID: 36181775 DOI: 10.1016/j.athoracsur.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 08/13/2022] [Accepted: 09/19/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND We developed an adventitial overlay method for reinforcing aortic anastomoses. This study evaluated the midterm morphologic and clinical outcomes of this method. METHODS We harvested and prepared adventitia from a resected aneurysm or dissected aortic wall and performed aortic repair using the adventitial overlay method. At the midterm follow-up, we examined the differences between overlay, inversion, and felt sandwich methods by evaluating the morphologic features of the anastomosis on computed tomography scans. Moreover, we performed macroscopic evaluation of 1 patient who required a second operation. RESULTS Between May 2009 and April 2020, 160 consecutive patients (104 men, 56 women; mean age, 68.6 ± 11 years; range, 39-88 years) underwent thoracic aortic surgery. The overlay technique was successfully performed in 84 cases. The anastomosis sites of the overlay method maintained their morphologic appearance without any clinical complications. The inner diameter ratio of anastomosis/graft was measured by computed tomography, which revealed that the overlay method was not significantly different from inversion and was significantly larger than the felt sandwich method. There was no anastomotic stenosis in the proximal or distal overlay anastomosis. Only 1 patient required a second operation for an enlarged aneurysm of the distal false lumen. We observed that the proximal overlaid adventitia was smoothly attached to the native lumen and was macroscopically indistinguishable from the original intima. CONCLUSIONS This study showed the midterm stability of the overlay technique. The midterm outcome was clinically acceptable. No anastomotic stenosis or pseudoaneurysm formation in either the true aortic aneurysm or dissection cases was observed.
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Affiliation(s)
- Takayuki Okada
- Department of Cardiovascular Surgery, Kansai Medical University, Osaka, Japan.
| | - Naoki Minato
- Department of Cardiovascular Surgery, Kansai Medical University, Osaka, Japan
| | - Nobuya Zempo
- Department of Cardiovascular Surgery, Kansai Medical University, Osaka, Japan
| | - Shinya Kanemoto
- Department of Cardiovascular Surgery, Kansai Medical University, Osaka, Japan
| | - Mitsuharu Hosono
- Department of Cardiovascular Surgery, Kansai Medical University, Osaka, Japan
| | - Shintaro Kuwauchi
- Department of Cardiovascular Surgery, Kansai Medical University, Osaka, Japan
| | - Tomohiko Uetsuki
- Department of Cardiovascular Surgery, Kansai Medical University, Osaka, Japan
| | - Takayuki Kawaura
- Department of Mathematics, Kansai Medical University, Osaka, Japan
| | - Tomoki Kitawaki
- Department of Mathematics, Kansai Medical University, Osaka, Japan
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3
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Montagner M, Kofler M, Falk V, Kempfert J. Instructions for use: when and how to glue the dissected aorta. Eur J Cardiothorac Surg 2023; 64:ezad332. [PMID: 37773992 DOI: 10.1093/ejcts/ezad332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/01/2023] Open
Affiliation(s)
- Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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4
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Zientara A, Tseng YT, Salmasi YM, Quarto C, Stock U. How to test adhesive strength: a biomechanical testing for aortic glue used in type a dissection repair. Eur J Cardiothorac Surg 2023; 64:ezad270. [PMID: 37522885 DOI: 10.1093/ejcts/ezad270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/28/2023] [Accepted: 07/28/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES The aim of this study was to develop a method to quantify the peel force in an in vitro model simulating repair of ascending aortic dissections with tissue glue (Bioglue). METHODS This study adapted an adhesive T-Peel test for the determination of the peel strength of adhesives by measuring the peeling force of a T-shaped bonded tissue. Measurements were performed on iatrogenic dissected ascending porcine aorta, which has been repaired with Bioglue using different pressure levels. Four conditions were tested: zero sample pressure according to the manufacturer's recommendation (n = 10), low (504 Pa; n = 11), moderate pressure (1711 Pa; n = 24) and pressure applied by a round shaped vascular 'Borst clamp' (1764 Pa; n = 23). Non-parametric one-way analysis of variance was applied for statistical significance. RESULTS The median peel force (lower quartile, upper quartile) of aortic samples increased depending on the applied pressure: [no pressure 0.030 N/mm (0.016, 0.057), low pressure 0.040 N/mm (0.032, 0.070) and moderate pressure 0.214 N/mm (0.050, 0.304)]. Samples pressurized with the Borst clamp reached 0.078 N/mm (0.046, 0.152), which was comparable to the peel force of the unpeeled controls [0.107 N/mm (0.087, 0.124)]. Compared to samples without pressure, Bioglue with the application of the Borst clamp (P = 0.021) and with moderate pressure (P = 0.0007) performed significantly better. CONCLUSIONS The novel T-Peel test offers an attractive method to test tissue glues in defined in vitro environments. Bioglue peel force increased with pressure on the aortic sample in contrast to low or no pressure as per the manufacturer's recommendation. Modifying current recommended use may aid in increasing effectiveness of this approach.
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Affiliation(s)
- Alicja Zientara
- Department of Cardiac Surgery, Royal Brompton Hospital, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Yuan-Tsan Tseng
- Magdi Yacoub Institute, Harefield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Yousuf Mohammad Salmasi
- Department of Cardiac Surgery, Harefield Hospital, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Cesare Quarto
- Department of Cardiac Surgery, Royal Brompton Hospital, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ulrich Stock
- Magdi Yacoub Institute, Harefield, UK
- Department of Cardiac Surgery, Harefield Hospital, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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6
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Lopez-Marco A, Yates MT, Adams B, Lall K, Yap J, Di Salvo C, Uppal R, Oo A. Managing the Root in Acute Type A Aortic Dissections: Are We Ready for a Standardized Approach? AORTA (STAMFORD, CONN.) 2023; 11:1-9. [PMID: 36848907 PMCID: PMC9970750 DOI: 10.1055/s-0042-1757947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 07/11/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Surgical repair of Type A aortic dissection (TAAD) requires exclusion of the primary entry tear and reestablishment of flow into the distal true lumen. Provided that the majority of tears occur within the ascending aorta (AA), replacing only that segment seems a safe option; however, this strategy leaves the root susceptible to dilatation and need for reintervention. We aimed to review the outcomes of the two strategies: aortic root replacement (ARR) and isolated ascending aortic replacement. METHODS Retrospective analysis of prospectively collected data for all consecutive patients who underwent repair of acute TAAD at our institution from 2015 to 2020 was conducted. Patients were divided into two groups: (1) ARR and (2) isolated AA replacement as index operation for TAAD repair. Primary outcomes were mortality and need for reintervention during the follow-up. RESULTS A total of 194 patients were included in the study; 68 (35%) in the ARR group and 126 (65%) in the AA group. There were no significant differences in postoperative complications or in-hospital mortality (23%; p = 0.51) between groups. Seven patients (4.7%) died during follow-up and eight patients underwent aortic reinterventions, including proximal aortic segments (two patients) and distal procedures (six patients). CONCLUSION Both aortic root and AA replacement are acceptable and safe techniques. The growth of an untouched root is slow, and reintervention in this aortic segment is infrequent compared with distal aortic segments, hence preserving the root could be an option for older patients provided that there is no primary tear within the root.
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Affiliation(s)
- Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Martin T. Yates
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Benjamin Adams
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Kulvinder Lall
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - John Yap
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Carmelo Di Salvo
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Rakesh Uppal
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
| | - Aung Oo
- Department of Cardiothoracic Surgery, St. Bartholomew's Hospital, London, United Kingdom
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A word of caution: Spontaneous rupture of the noncoronary sinus of the Freestyle xenograft: Two cases and review of the literature. JTCVS OPEN 2022; 11:59-61. [PMID: 36172406 PMCID: PMC9510863 DOI: 10.1016/j.xjon.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
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8
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Cavozza C, Regesta T, Campanella A, Camporini G, Audo A. Partially Resorbable Mesh Inclusion between Dissected Layers during Surgical Repair of Aortic Dissection. AORTA 2021; 9:235-237. [PMID: 34963167 PMCID: PMC8714316 DOI: 10.1055/s-0041-1729919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgical management of aortic dissection is technically challenging for different reasons. Reapproximation of dissected layers because of fragility of the dissected aortic wall layers is of major concern. Many techniques have been described to restore the integrity of aortic wall. Inclusion of a partially resorbable mesh fixed with glue, between the dissected layers, may be a simple and effective method for providing a secure and viable end-to-end anastomosis between aortic stump and a Dacron graft.
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Affiliation(s)
- Corrado Cavozza
- Department of Cardiothoracic and Vascular Surgery, Cardiac Surgery, Santissimi Antonio e Biagio Hospital, Alessandria, Italy
| | - Tommaso Regesta
- Department of Cardiothoracic and Vascular Surgery, Cardiac Surgery, Santissimi Antonio e Biagio Hospital, Alessandria, Italy
| | - Antonio Campanella
- Department of Cardiothoracic and Vascular Surgery, Cardiac Surgery, Santissimi Antonio e Biagio Hospital, Alessandria, Italy
| | - Glauco Camporini
- Department of Cardiothoracic and Vascular Surgery, Cardiac Surgery, Santissimi Antonio e Biagio Hospital, Alessandria, Italy
| | - Andrea Audo
- Department of Cardiothoracic and Vascular Surgery, Cardiac Surgery, Santissimi Antonio e Biagio Hospital, Alessandria, Italy
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9
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Koto S, Imai K, Yamada R, Kume T, Neishi Y, Uemura S. A case of rupture of right coronary sinus of Valsalva aneurysm after aortic root replacement due to Stanford type A aortic dissection 15 years ago. J Echocardiogr 2021; 20:130-131. [PMID: 33389668 PMCID: PMC9156452 DOI: 10.1007/s12574-020-00505-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Satoshi Koto
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Koichiro Imai
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
| | - Ryotaro Yamada
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Teruyoshi Kume
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yoji Neishi
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
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10
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Ohno N, Maeda T, Kato O, Sato H, Ueno G, Yoshizawa K. Neomedia Repair of the Valsalva Sinus in the Treatment of Acute Type-A Aortic Dissection: Long-term Effectiveness and a Case of Pathology. Ann Vasc Dis 2020; 13:248-254. [PMID: 33384726 PMCID: PMC7751080 DOI: 10.3400/avd.oa.20-00113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although numerous surgical techniques are employed to treat acute Stanford type A aortic dissection (ATAAD), controversy remains over which is the best procedure for aortic root reconstruction. Among the various techniques utilized, neomedia repair is considered to be more promising than adhesive-only repair for the treatment of a dissected aortic root. We experienced a series of neomedia sinus Valsalva repair using woven polyester fabric, and evaluated the aortic root diameter by computed tomography and severity of aortic valve insufficiency by transthoracic echocardiography. The aortic root diameter was well preserved with no progress of aortic valve insufficiency in the long-term period. Furthermore, we found that the fabric looked functioning new media in the findings obtained from the pathological examination of a neomedia repaired aortic wall sample that was obtained by chance from a patient during valve replacement surgery performed 10 years after aortic reconstruction for ATAAD. Neomedia repair using woven polyester fabric for ATAAD might facilitate the long-term durability of the surgically treated aortic root. (This is a translation of J Jpn Coll Angiol 2019; 59: 37–43.)
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Affiliation(s)
- Nobuhisa Ohno
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Toshi Maeda
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Otohime Kato
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Hirofumi Sato
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Go Ueno
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
| | - Kosuke Yoshizawa
- Department of Cardiovascular Surgery, Amagasaki General Medical Center
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11
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Zhu C, Piao H, Wang Y, Wang T, Li D, Xu R, Zhu Z, Li B, Zhang Y, Liu K. A New Aortic Root Reinforcement Technique for Acute Type A Aortic Dissection Surgery. Int Heart J 2019; 60:1131-1136. [DOI: 10.1536/ihj.18-609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cuilin Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Hulin Piao
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yong Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Tiance Wang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Dan Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Rihao Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Zhicheng Zhu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Bo Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Yixin Zhang
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
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12
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Survival and reoperation after valve-sparing root replacement and root repair in acute type A dissection. J Thorac Cardiovasc Surg 2018; 156:2076-2082.e2. [DOI: 10.1016/j.jtcvs.2018.05.096] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/15/2018] [Accepted: 05/25/2018] [Indexed: 11/18/2022]
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13
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Tanaka H, Ikeno Y, Abe N, Takahashi H, Inoue T, Okita Y. Outcomes of valve-sparing root replacement in acute Type A aortic dissection. Eur J Cardiothorac Surg 2018; 53:1021-1026. [DOI: 10.1093/ejcts/ezx463] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/28/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hiroshi Tanaka
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | - Yuki Ikeno
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | - Noriyuki Abe
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | | | - Takeshi Inoue
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Kobe University, Kobe, Japan
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14
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Kim JY, Kim IH, Heo W, Min HK, Kang DK, Hwang YH, Jun HJ. A New Root-Strengthening Technique for Acute Aortic Dissection with a Weakened Aortic Root: The Neo-Adventitia Technique. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:436-442. [PMID: 29234610 PMCID: PMC5716646 DOI: 10.5090/kjtcs.2017.50.6.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022]
Abstract
Background Dissection flaps in acute type A aortic dissection typically extend into the root, most frequently into the non-coronary sinus (NCS). The weakened root can be susceptible not only to surgical trauma, but also to future dilatation because of its thinner layers. Herein, we describe a new technique that we named the “neo-adventitia” technique to strengthen the weakened aortic root. Methods From 2012 to 2016, 27 patients with acute type A aortic dissection underwent supracommissural graft replacement using our neo-adventitia technique. After we applied biologic glue between the dissected layers, we wrapped the entire NCS and the partial left and right coronary sinuses on the outside using a rectangular Dacron tube graft that served as neo-adventitia to reinforce the dissected weakened wall. Then, fixation with subannular stitches stabilized the annulus of the NCS. Results There were 4 cases of operative mortality, but all survivors were discharged with aortic regurgitation (AR) classified as mild or less. Follow-up echocardiograms were performed in 10 patients. Of these, 9 showed mild or less AR, and 1 had moderate AR without root dilatation. There were no significant differences in the size of the aortic annulus (p=0.57) or root (p=0.10) between before discharge and the last follow-up echocardiograms, and no reoperations on the aortic roots were required during the follow-up period. Conclusion This technique is easy and efficient for reinforcing and stabilizing weakened roots. Furthermore, this technique may be an alternative for restoring and maintaining the geometry of the aortic root. An externally reinforced NCS could be expected to resist future dilatation.
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Affiliation(s)
- Ji Yong Kim
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine
| | - In Ha Kim
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine
| | - Woon Heo
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine
| | - Ho-Ki Min
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine
| | - Do Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine
| | - Youn-Ho Hwang
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine
| | - Hee Jae Jun
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine
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Woo W, Hong S, Kim TH, Baek MY, Song SW. Delayed Pulmonary Artery Rupture after Using BioGlue in Cardiac Surgery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:474-476. [PMID: 29234619 PMCID: PMC5716655 DOI: 10.5090/kjtcs.2017.50.6.474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 11/29/2022]
Abstract
A 56-year-old woman, who underwent cardiac surgery 3 months previously, presented to the emergency room with pulmonary artery rupture due to the cytotoxic effects of BioGlue (CryoLife Inc., Kennesaw, GA, USA). She was successfully treated with surgical management. Although surgical glue can be effectively used for hemostasis, it can induce delayed vascular complications. Therefore, surgical glue should be used cautiously.
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Affiliation(s)
- Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Soonchang Hong
- Department of Thoracic and Cardiovascular Surgery, Yonsei University Wonju College of Medicine
| | - Tae-Hoon Kim
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Min-Young Baek
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Suk-Won Song
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
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Ma WG, Ziganshin BA, Guo CF, Zafar MA, Sieller RS, Tranquilli M, Elefteriades JA. Does BioGlue contribute to anastomotic pseudoaneurysm after thoracic aortic surgery? J Thorac Dis 2017; 9:2491-2497. [PMID: 28932555 DOI: 10.21037/jtd.2017.06.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although bovine serum albumin-glutaraldehyde glue (BioGlue®) has been successfully used as a hemostatic adjunct in aortic surgical procedures, there are reports that it may lead to anastomotic pseudoaneurysm formation. We seek to examine if the use of BioGlue is associated with a high incidence of anastomotic pseudoaneurysm formation following surgical repair of thoracic aortic disease. METHODS We reviewed the medical records and follow-up computed tomography (CT) scans of patients from 2001 to 2015 in whom BioGlue was used during surgical repair of thoracic aortic disease to detect postoperative anastomotic pseudoaneurysm formation. RESULTS A total of 233 patients with BioGlue use were identified. Mean age was 63.5±14.0 years (median 66; range 14-88; 25-75%, IQR 54-74 years) and 149 were male (63.9%). Surgical indication was thoracic aortic aneurysm in 169 (72.5%) patients, aortic dissection in 49 (21.0%), intramural hematoma in 9 (3.9%), penetrating aortic ulcer in 3 (1.3%) and other in 3 (1.3%). Emergency/urgent surgery was performed in 68 cases (29.2%). Operative mortality was 7.3% (17/233). Re-exploration for bleeding and neurologic deficits occurred in 24 (10.3%) and 21 (9.0%) patients respectively. All operative survivors were followed (100%, 216/216) and CT follow-up was available in 81.9% (177/216) for a mean duration of 2.4 years (median 0.6; 25-75% IQR 0.2-3.6 years). Anastomotic pseudoaneurysm was detected in 1 patient (0.6%) at 3 years postoperatively. This was an elderly female with extremely frail tissues who underwent a reoperative ascending and arch replacement for dissection. CONCLUSIONS The use of BioGlue in thoracic aortic surgery was not associated with excess incidence of anastomotic pseudoaneurysm formation following surgical repair of thoracic aortic disease. Its use need not be discouraged on this basis.
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Affiliation(s)
- Wei-Guo Ma
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.,Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.,Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia
| | - Chang-Fa Guo
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.,Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Richard S Sieller
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Maryann Tranquilli
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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Chiu P, Trojan J, Tsou S, Goldstone AB, Woo YJ, Fischbein MP. Limited root repair in acute type A aortic dissection is safe but results in increased risk of reoperation. J Thorac Cardiovasc Surg 2017; 155:1-7.e1. [PMID: 29042100 DOI: 10.1016/j.jtcvs.2017.08.137] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/28/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Management of the aortic root is a challenge for surgeons treating acute type A aortic dissection. METHODS We performed a retrospective review of the acute type A aortic dissection experience at Stanford Hospital between 2005 and 2015 and identified patients who underwent either limited root repair or aortic root replacement. Differences in baseline characteristics were balanced with inverse probability weighting to estimate the average treatment effect on the controls. Weighted logistic regression was used to evaluate in-hospital mortality. Weighted Cox proportional hazards regression was used to evaluate differences in the hazard for mid-term death. Reoperation was evaluated with death as a competing risk with the Fine-Gray subdistribution hazard. RESULTS After we excluded patients managed either nonoperatively or with definitive endovascular repair, there were 293 patients without connective tissue disease who underwent either limited root repair or aortic root replacement. There was no difference in weighted perioperative mortality, odds ratio 0.89 (95% confidence interval [CI], 0.44-1.76, P = .7), and there was no difference in weighted survival, hazard ratio 1.12 (95% CI, 0.54-2.31, P = .8). Risk of reoperation was greater in limited root repair (11.8%, 95% CI, 0.0%-23.8%) than for root replacement (0%), P < .001. CONCLUSIONS Limited root repair was associated with increased risk of late reoperation after repair of acute type A aortic dissection. Surgeons with adequate experience may consider aortic root replacement in well-selected patients. However, given good outcomes after limited root repair, surgeons should not feel compelled to perform this more-complex operation.
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Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif; Division of Health Research and Policy, Stanford University, School of Medicine, Stanford, Calif
| | - Jeffrey Trojan
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - Sarah Tsou
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif; Division of Health Research and Policy, Stanford University, School of Medicine, Stanford, Calif
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif.
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Molteni M, De Chiara B, Casadei F, Botta L, Merlanti B, Russo CF, Giannattasio C, Moreo A. Late Echocardiographic Study of Aortic Valve and Aortic Root after Surgery for Type A Acute Aortic Dissection. J Cardiovasc Echogr 2017; 26:78-82. [PMID: 28465967 PMCID: PMC5224673 DOI: 10.4103/2211-4122.187948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: In case of concomitant aortic regurgitation (AR) valve, sparing operation is considered the first choice in selected patients. The aim of this retrospective clinical and echocardiographic study was to evaluate the long-term survival results of conservative approach and the determinants of recurrent AR. Methods: From 2000 to 2011, fifty patients (median: 63 years and interquartile range: 53–72) underwent an aortic valve-sparing procedure for acute aortic dissection, and discharged alive. The long-term clinical and echocardiographic outcome was analyzed. Results: Late all-causes mortality was 18% (nine patients) at a median follow-up of 55.8 months. Ten patients (20%) underwent re-operations, five of them for aortic valve/root recurrent disease; freedom from proximal re-operation was 90%. Two-third of the patients had a preoperative AR grade <3; a non-negligible number of patients with acute significant AR (23% with grade ≥3) at the time of surgery underwent conservative aortic valve surgery. At a median echocardiographic follow-up of 50.5 months, we found no significant correlation between late recurrent AR and AR grade at the time of surgery and the aortic root diameter. Late recurrent AR grade was significantly higher in patients who underwent aortic commissures and cusps resuspension than those who underwent lone ascending aorta replacement (2.29 ± 1.05 vs. 1.58 ± 1.03, P = 0.028). Conclusions: Preoperative AR and late aortic root diameter were not the predictors of late AR. Late AR is higher in patients who underwent aortic commissures and cusps resuspension compared to the only replacement of the ascending aorta.
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Affiliation(s)
- Martina Molteni
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Francesca Casadei
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Luca Botta
- Department of Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Bruno Merlanti
- Department of Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | | | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
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Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg 2016; 5:275-95. [PMID: 27563541 DOI: 10.21037/acs.2016.05.05] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.
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Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
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20
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Oda T, Minatoya K, Sasaki H, Tanaka H, Seike Y, Itonaga T, Inoue Y, Kobayashi J. Adventitial inversion technique for type A aortic dissection distal anastomosis. J Thorac Cardiovasc Surg 2016; 151:1340-5. [DOI: 10.1016/j.jtcvs.2016.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 12/29/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
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21
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Urbanski PP, Lenos A, Irimie V, Bougioukakis P, Zacher M, Diegeler A. Acute aortic dissection involving the root: operative and long-term outcome after curative proximal repair. Interact Cardiovasc Thorac Surg 2016; 22:620-6. [PMID: 26848190 DOI: 10.1093/icvts/ivw002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/04/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The aim of the study was to evaluate operative and long-term results after surgery of acute aortic dissection involving the root, in which the proximal repair consisted of curative resection of all dissected aortic sinuses and was performed using either valve-sparing root repair or complete root replacement with a valve conduit. METHODS Between August 2002 and March 2013, 162 consecutive patients (mean age 63 ± 14 years) underwent surgery for acute type A aortic dissection. Eighty-six patients with an involvement of the aortic root underwent curative surgery of the proximal aorta consisting of valve-sparing root repair (n = 54, 62.8%) or complete valve and root replacement using composite valve grafts (n = 32, 37.2%). In patients with root repair, all dissected aortic walls were resected and root remodelling using the single patch technique (n = 53) or root repair with valve reimplantation (n = 1) was performed without the use of any glue. All perioperative data were collected prospectively and retrospective statistical examination was performed using univariate and multivariate analyses. RESULTS The mean follow-up was 5.2 ± 3.5 years for all patients (range 0-12 years) and 6.1 ± 3.3 years for survivors. The 30-day mortality rate was 5.8% (5 patients), being considerably lower in the repair sub-cohort (1.9 vs 12.5%). The estimated survival rate at 5 and 10 years was 80.0 ± 4.5 and 69.1 ± 6.7%, respectively. No patient required reoperation on the proximal aorta and/or aortic valve during the follow-up time and there were only two valve-related events (both embolic, one in each group). Among those patients with repaired valves, the last echocardiography available showed no insufficiency in 40 and an irrelevant insufficiency (1+) in 14. CONCLUSIONS Curative repair of the proximal aorta in acute dissection involving the root provides favourable operative and long-term outcome with very low risk of aortic complications and/or reoperations, regardless if a valve-sparing procedure or replacement with a valve conduit is used. Valve-sparing surgery is frequently suitable, providing excellent outcome and very high durability.
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Affiliation(s)
| | | | - Vadim Irimie
- Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | | | - Michael Zacher
- Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Anno Diegeler
- Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
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Endovascular Repair for Thoracic Aortic False Aneurysms: Single-Center Experience in 102 Patients. Ann Thorac Surg 2015; 101:1410-7. [PMID: 26652142 DOI: 10.1016/j.athoracsur.2015.09.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 08/15/2015] [Accepted: 09/15/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thoracic aortic false aneurysm is unusual and experience with endovascular repair is limited. We evaluate the efficacy of endovascular repair in patients with thoracic aortic false aneurysms. METHODS The early and midterm outcomes of endovascular repair in 102 patients with thoracic aortic false aneurysms were analyzed. RESULTS There were 80 men and 22 women (age 54.9 ± 13.7 years). Emergent or urgent endovascular repair was done in 19 cases (18.6%) and elective in 83 (81.4%). Procedure was successful in 99.0%. Early death occurred in 4 patients (3.9%). No early death occurred in elective patients. Early complications occurred in 7 patients (6.9%). Follow-up was complete in 100% for 24.0 ± 18.5 months (range, 1.5 to 67.3). Fourteen late deaths occurred (13.7%). Late events occurred in 9 patients (8.8%). Survival at 6 month, 1 year and 3 years was 90.7%, 86.7% and 84.5%, respectively. CONCLUSIONS Satisfactory early and midterm outcomes have been achieved with endovascular repair in this series. Although emergent or urgent patients had higher rates of early mortality and morbidity, the majority of them achieved stable late survival as long as they survived at least 6 months. These results argue favorably for use of endovascular repair in the management of patients with thoracic aortic false aneurysms.
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Effect of the Bioadhesive, BioGlue, on Impaired Colonic Anastomose Healing in Rats. Int Surg 2015. [DOI: 10.9738/intsurg-d-15-00085.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Colonic anastomotic leakage is still a problem in general surgery practice. We sought to investigate the effect of a new tissue adhesive, BioGlue, on the healing of normal and impaired colonic anastomoses. Sixty-four rats were randomized into 4 groups. In all animals, a 1-cm segment of the left colon was resected, and an end-to-end sutured anastomosis was created. Animals were then divided into 2 groups: normal and impaired anastomosis. These 2 groups were further subdivided into 2 additional groups: animals that received BioGlue and those that did not. All rats received intraperitoneal injections of either 0.9% NaCl or 5-fluorouracil (5-FU). Anastomotic evaluation was done 7 days after surgery. Macroscopic healing, mechanical strength, and histopathologic healing parameters were evaluated. Leakage of the anastomosis was significantly higher in rats in the impaired group compared with those in the BioGlue groups (P = 0.043). The adhesion formation score was significantly higher in rats in the impaired anastomosis group compared with the other groups. Bursting pressures were significantly lower in the impaired anastomosis group than in the other ones (P = 0.001). Neoangiogenesis and fibroblast activity were different among the groups (P = 0.001). Inflammatory cell infiltration and collagen deposition did not differ among the groups (P = 0.07). Immediate postoperative intraperitoneal administration of 5-FU after colonic anastomosis inhibits intestinal wound healing. Covering colon anastomoses with BioGlue after suturing conferred beneficial effect on healing.
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Hsu RB, Chen JW. Low Incidence of Late Pseudoaneurysm and Reoperation After Conventional Repair of Acute Type A Aortic Dissection. J Card Surg 2014; 29:641-6. [DOI: 10.1111/jocs.12359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ron-Bin Hsu
- Department of Surgery, National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan ROC
| | - Jeng-Wei Chen
- Department of Surgery, National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan ROC
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25
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Ergüneş K, Yilik L, Yurekli I, Celik E, Gurbuz A. Surgery for false aneurysm developing after type A acute aortic dissection. Asian Cardiovasc Thorac Ann 2014; 23:1090-2. [PMID: 24803546 DOI: 10.1177/0218492314534248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic false aneurysm is life-threatening with high morbidity and mortality rates. Surgical treatment varies according to the pathologic process, infection status, and site of origin of the aneurysm. We presented a case of false aneurysm of the ascending aorta, developing after type A acute aortic dissection repair. The operation was performed with the use of deep hypothermia and circulatory arrest to avoid massive uncontrollable hemorrhage.
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Affiliation(s)
- Kazım Ergüneş
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Levent Yilik
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ismail Yurekli
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ersin Celik
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ali Gurbuz
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Autologous adventitial overlay method reinforces anastomoses in aortic surgery. Ann Thorac Surg 2014; 97:1814-5. [PMID: 24792283 DOI: 10.1016/j.athoracsur.2013.09.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 08/27/2013] [Accepted: 09/13/2013] [Indexed: 11/21/2022]
Abstract
In this study, we present an inexpensive and effective method for providing a secure and hemostatic anastomosis using autologous adventitia obtained from a dissected or aneurysmal wall. The resected aortic wall is separated between the adventitia and media, and a soft, 2 × 10-cm adventitial strip is overlaid to cover the anastomotic margin. A graft is sutured to the aortic stump. This autologous adventitial overlay method can inexpensively and strongly reinforce the anastomosis during aortic surgery for dissection or aneurysm and will contribute to anastomotic hemostasis and long-term stability.
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27
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Peng HT, Shek PN. Novel wound sealants: biomaterials and applications. Expert Rev Med Devices 2014; 7:639-59. [DOI: 10.1586/erd.10.40] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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28
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The use of surgical glue in acute type A aortic dissection. Gen Thorac Cardiovasc Surg 2013; 62:207-13. [DOI: 10.1007/s11748-013-0343-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Indexed: 11/26/2022]
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Lisy M, Kahlil M, Stock UA, Wildhirt SM. Fibrin sealant patch for repair of acute type a aortic dissection. J Card Surg 2013; 28:736-41. [PMID: 23957708 DOI: 10.1111/jocs.12208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of glues to repair disrupted tissue during acute type-A aortic dissection (TAD) surgery may be discontinuous, and cause embolization and cell necrosis. We report a method of fibrin sealant patch (FSP) to reinforce dissected aortic tissue with a collagen double layer coated with fibrinogen/thrombin on either side (TachoSil®; Takeda, Konstanz, Germany). METHODS In 12 patients (seven male, 66.9 ± 11.7 years) with acute TAD we performed FSP of the intima-media disruption at the proximal and distal anastomosis of the aorta. We analyzed the perioperative course and echocardiographical, radiological, and clinical outcomes up to one year. Additionally, we investigated the adhesive potential of the FSP in vitro. RESULTS In vitro, the adhesive strength of the FSP was 60 N/cm(2). In-hospital mortality was 8.3% (n = 1), recovery was satisfactory with no major neurologic events, mean ICU stay was 13.6 ± 6.0 days, mean hospital stay was 20.7 ± 4.4 days. A total of 7.0 ± 2.6 RBC, 3.4 ± 1.5 platelets, and 8.0 ± 4.3 FFP were transfused. One-year survival was 83.3%. In 6/6 DeBakey II dissections the intimal tear was completely resected, in 2/6 DeBakey I dissections the false lumen in the descending aorta completely collapsed. No redissections and no relevant aortic valve insufficiencies were seen during follow-up. CONCLUSION This analysis shows that FSP using a collagen matrix double layer coated with fibrinogen/thrombin is feasible, safe, and effective in repairing the dissected aortic tissue. It results in continuous reinforcement of aortic tissue and completely avoids the need for conventional glues.
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Affiliation(s)
- Milan Lisy
- Department of Vascular Surgery, Hoechst Hospital Frankfurt, Frankfurt, Germany
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Olsson C, Hillebrant CG, Liska J, Lockowandt U, Eriksson P, Franco-Cereceda A. Mortality and reoperations in survivors operated on for acute type A aortic dissection and implications for catheter-based or hybrid interventions. J Vasc Surg 2013; 58:333-339.e1. [DOI: 10.1016/j.jvs.2012.12.078] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/21/2012] [Accepted: 12/26/2012] [Indexed: 11/29/2022]
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Svensson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria JE, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reardon M, Reece TB, Reiss GR, Roselli EE, Smith CR, Thourani VH, Tuzcu EM, Webb J, Williams MR. Aortic Valve and Ascending Aorta Guidelines for Management and Quality Measures. Ann Thorac Surg 2013; 95:S1-66. [DOI: 10.1016/j.athoracsur.2013.01.083] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 12/24/2012] [Accepted: 01/15/2013] [Indexed: 12/31/2022]
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Urbanski PP, Hijazi H, Dinstak W, Diegeler A. Valve-sparing aortic root repair in acute type A dissection: how many sinuses have to be repaired for curative surgery?†. Eur J Cardiothorac Surg 2013; 44:439-43; discussion 443-4. [DOI: 10.1093/ejcts/ezt042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Complications of Bioglue postsurgery for aortic dissections and aortic valve replacement. J Clin Pathol 2012; 65:1008-12. [DOI: 10.1136/jclinpath-2012-200809] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AimsBioglue is an adhesive used during cardiovascular surgery to improve hemostasis perioperatively and to strengthen and reinforce vascular anastomoses. It has also been used to ‘seal’ the false lumen in patients presenting with acute aortic dissections. Herein, we examine the complications of Bioglue, which may lead to redo sternotomy in selected patients.MethodsA review of pathology records at our institution from 2002 to 2010 found 4 cases of excised aortic tissue and/or aortic valves with previous Bioglue® use at initial operation. Excised tissues and valves were examined, looking for the presence of Bioglue®, inflammatory cells (acute, chronic, macrophage and giant cells) and micro-organisms. Patient demographics were also reviewed and recorded.ResultsWe identified four cases of Bioglue use found at redo surgery, after the formation of pseudoaneurysm (n=3) and aortic stenosis (n=1). Mean interval to redo surgery was 2.28 + 0.32 years (range 2-2.6 years). Pseudoaneurysm formation was thought to be caused by an inflammatory reaction to the Bioglue® itself in two cases, while one case found no such reaction. One patient with previous aortic valve replacement had large annular abscesses filled with necrotic debris surrounding the prosthesis and pannus found on the sewing cuff, comprised of Bioglue® itself.ConclusionsThe mechanisms leading to these complications include mechanical strain, inflammation and tissue necrosis. The judicious use of Bioglue® when clinically indicated, and close follow-up of these patients with serial imaging, remain an integral part of avoiding future complications.
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A case of ascending aortic pseudoaneurysm in a patient with aortic replacement. Gen Thorac Cardiovasc Surg 2012; 60:443-5. [PMID: 22544426 DOI: 10.1007/s11748-012-0022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 07/21/2011] [Indexed: 10/28/2022]
Abstract
A 59-year-old man with a history of ascending aorta replacement for an aortic dissection using gelatin-resorcin-formalin glue at age of 50 years presented with paroxysmal nocturnal dyspnea. An echocardiogram showed severe aortic regurgitation associated with aortic root enlargement. Chest computed tomography showed that the ascending aorta was dilated and a pseudoaneurysm was observed around the implanted prosthetic graft. Upon opening the ascending aorta, we found that the posterior wall of the proximal anastomotic portion of the implanted graft was ruptured. After replacement of the aortic root with a composite graft and reconstruction of the orifices of the right and left coronary arteries, total arch replacement by the separated graft technique was performed. The postoperative course was uneventful.
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Karck M. The glue crisis in surgery of acute aortic dissection type A is ongoing. Eur J Cardiothorac Surg 2012; 41:e36-7. [DOI: 10.1093/ejcts/ezs020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol 2012; 58:2455-74. [PMID: 22133845 DOI: 10.1016/j.jacc.2011.06.067] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 06/07/2011] [Indexed: 01/11/2023]
Abstract
Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.
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Amirghofran AA, Rayatpisheh S, Tanideh N, Owji AA, Vasei A, Mehrabani D. Evaluation of Different Formulations of Biological Surgical Adhesives on Hemorrhagic Aorta: AnIn vitroand Animal, Study. JOURNAL OF APPLIED ANIMAL RESEARCH 2011. [DOI: 10.1080/09712119.2005.9706805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - N. Tanideh
- b Department of Pharmacology, Laboratory Animal Research Centre
| | | | | | - D. Mehrabani
- e Razi Vaccine and Serum Research Institute Gastroenterohepatology Research Centre School of Medicine Shiraz University of Medical Sciences , Shiraz , 71345 , Iran
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Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, Song HK, Clough ER, Shore-Lesserson LJ, Goodnough LT, Mazer CD, Shander A, Stafford-Smith M, Waters J, Baker RA, Dickinson TA, FitzGerald DJ, Likosky DS, Shann KG. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011; 91:944-82. [PMID: 21353044 DOI: 10.1016/j.athoracsur.2010.11.078] [Citation(s) in RCA: 878] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 11/20/2010] [Accepted: 11/29/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Practice guidelines reflect published literature. Because of the ever changing literature base, it is necessary to update and revise guideline recommendations from time to time. The Society of Thoracic Surgeons recommends review and possible update of previously published guidelines at least every three years. This summary is an update of the blood conservation guideline published in 2007. METHODS The search methods used in the current version differ compared to the previously published guideline. Literature searches were conducted using standardized MeSH terms from the National Library of Medicine PUBMED database list of search terms. The following terms comprised the standard baseline search terms for all topics and were connected with the logical 'OR' connector--Extracorporeal circulation (MeSH number E04.292), cardiovascular surgical procedures (MeSH number E04.100), and vascular diseases (MeSH number C14.907). Use of these broad search terms allowed specific topics to be added to the search with the logical 'AND' connector. RESULTS In this 2011 guideline update, areas of major revision include: 1) management of dual anti-platelet therapy before operation, 2) use of drugs that augment red blood cell volume or limit blood loss, 3) use of blood derivatives including fresh frozen plasma, Factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant Factor VII, antithrombin III, and Factor IX concentrates, 4) changes in management of blood salvage, 5) use of minimally invasive procedures to limit perioperative bleeding and blood transfusion, 6) recommendations for blood conservation related to extracorporeal membrane oxygenation and cardiopulmonary perfusion, 7) use of topical hemostatic agents, and 8) new insights into the value of team interventions in blood management. CONCLUSIONS Much has changed since the previously published 2007 STS blood management guidelines and this document contains new and revised recommendations.
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Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. II. The intra-operative period. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:189-217. [PMID: 21527082 PMCID: PMC3096863 DOI: 10.2450/2011.0075-10] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Kim SW, Sung K, Lee YT, Kim WS, Park PW, Jun TG, Yang JH. Aortic false lumen patency following the adventitial inversion technique for acute DeBakey type I aortic dissection. J Card Surg 2011; 25:548-53. [PMID: 20678107 DOI: 10.1111/j.1540-8191.2010.01099.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We determined the beneficial effect of the adventitial inversion technique on reducing the patency rate of false lumens in acute aortic dissection (AAD) compared with the sandwich technique using Teflon felts. METHODS Between 2003 and 2008, 65 consecutive patients with DeBakey type I AAD underwent emergent surgery. To obliterate a false lumen, the sandwich technique was used in 35 patients (group TS) before October 2006 and the adventitial inversion technique was used in 30 patients (group AIT) subsequent to October 2006. The false lumen patency was evaluated with computerized tomo-angiography (CTA). RESULTS There were three operative deaths (AIT [n = 1]; TS [n = 2]). The operative morbidity rate was not different (AIT = 17.2%, TS = 21.2%). Follow-up was completed in 56 patients (90.3%) with a mean duration of 12.2 ± 4.9 months in the group AIT and 31.8 ± 19.8 months in the group TS. During the follow-up period, there were no deaths or aortic events. In 53 patients (AIT [n = 26]; TS [n = 27]), a postoperative one-year CTA was obtained and compared with that of immediate postoperative one. The patency rate in the immediate postoperative period was 30.8% in group AIT and 63.0% in group TS (p = 0.019). On the follow-up CTA, it was 15.4% in group AIT and 48.1% in group TS (p = 0.018), respectively. CONCLUSIONS The adventitial inversion technique can be performed safely and obliterate the false lumen more effectively than the sandwich technique. The adventitial inversion technique might decrease the incidence of reoperations related to aneurysmal changes and improve survival or event-free survival.
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Affiliation(s)
- Su Wan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Khan H, Chaubey S, Desai J. Early Failure of Coronary Artery Bypass Grafts: An Albumin Cross-Linked Glutaraldehyde (BioGlue) Related Complication. J Card Surg 2011; 26:264-6. [DOI: 10.1111/j.1540-8191.2011.01208.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El Feghaly M, Chahine E, Abi Ghanem M, Abou Zahr O, Alayli M, Abu Khalil B. Acute limb ischaemia due to embolisation of biological glue 45 days after surgery. Eur J Vasc Endovasc Surg 2011; 41:518-20. [PMID: 21232993 DOI: 10.1016/j.ejvs.2010.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Since their introduction, biological glues have been more often used in cardiac and vascular surgery in order to control bleeding and reinforce surgical anastomotic sites. REPORT We report a case of a 54-year-old woman diagnosed with acute limb ischaemia due to embolisation of biological glue, 45 days after her surgery for ascending aortic dissection. Her ischaemia was successfully relieved by an urgent thrombectomy. DISCUSSION Complications due to the use of biological glues remain rare but are very serious. Preventive measures and intra-operative precautions must be considered in order to avoid most of these complications.
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Affiliation(s)
- M El Feghaly
- Department of Vascular Surgery, St Georges Hospital, University Medical Center, Beirut, Lebanon.
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Weiner J, Widman S, Golek Z, Tranquilli M, Elefteriades JA. Role of Bovine Serum Albumin-Glutaraldehyde Glue in the Formation of Anastomatic Pseudoaneurysms. J Card Surg 2010; 26:76-81. [DOI: 10.1111/j.1540-8191.2010.01162.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vidal V, Rolland PH, Daniel L, Moulin G, Bartoli JM, Levrier O. Effectiveness of Endovascular Embolization with a Collagen-based Embolic Agent (Marsembol) in an Animal Model. J Vasc Interv Radiol 2010; 21:1419-23. [DOI: 10.1016/j.jvir.2010.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 04/07/2010] [Accepted: 04/14/2010] [Indexed: 12/01/2022] Open
Affiliation(s)
- Vincent Vidal
- School of Medicine, Laboratory of Physiopathology and Vascular Therapeutics, Hôpital La Timone, 27 boulevard Jean Moulin, 13385 Marseille cedex 5, France.
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Operative Techniken zur chirurgischen Therapie der akuten Typ-A-Dissektion. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2009. [DOI: 10.1007/s00398-009-0750-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Witter K, Tonar Z, Matějka VM, Martinča T, Jonák M, Rokošný S, Pirk J. Tissue reaction to three different types of tissue glues in an experimental aorta dissection model: a quantitative approach. Histochem Cell Biol 2009; 133:241-59. [DOI: 10.1007/s00418-009-0656-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2009] [Indexed: 12/14/2022]
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Barnard J, Millner R. A Review of Topical Hemostatic Agents for Use in Cardiac Surgery. Ann Thorac Surg 2009; 88:1377-83. [DOI: 10.1016/j.athoracsur.2009.02.092] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/26/2009] [Accepted: 02/27/2009] [Indexed: 11/16/2022]
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Iliopoulos DC, Deveja AR, Satratzemis V, Koudoumas DG. Deep Hypothermic Arrest for Aortic Valve Replacement in Case of Porcelain Aorta. Asian Cardiovasc Thorac Ann 2009; 17:415-6. [DOI: 10.1177/0218492309338092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 71-year-old man presented with severe aortic stenosis and a heavily calcified aorta. Cardiopulmonary bypass was established with arterial cannula via the distal aortic arch. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were initiated for excision of the ascending aorta. A tube graft was anastomosed to the proximal aortic arch, circulation was reestablished, the aortic valve was replaced with a bioprosthesis, and proximal anastomosis to the sinotubular junction was preformed.
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Affiliation(s)
| | - Aris-Rezar Deveja
- University of Athens School of Medicine Athens Medical Center Athens, Greece
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Kimura N, Tanaka M, Kawahito K, Yamaguchi A, Ino T, Adachi H. Early postoperative aortic rupture following surgery for acute type A aortic dissection. Interact Cardiovasc Thorac Surg 2009; 8:431-4. [DOI: 10.1510/icvts.2008.197491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Azadani AN, Matthews PB, Ge L, Shen Y, Jhun CS, Guy TS, Tseng EE. Mechanical Properties of Surgical Glues Used in Aortic Root Replacement. Ann Thorac Surg 2009; 87:1154-60. [DOI: 10.1016/j.athoracsur.2008.12.072] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 12/19/2008] [Accepted: 12/22/2008] [Indexed: 11/17/2022]
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